Healthy Skepticism Library item: 18680

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Moynihan R
A health check for the business of medicine
ABC News 2010 Sep 3
http://www.abc.net.au/unleashed/stories/s3001738.htm

Full text:

A very senior doctor told me quite a few years back that he’d stopped going to drug company funded scientific conferences, because he couldn’t stand the smell any longer.

The sensitive medico never specified the exact nature of the offending odour, but it may well have been the sour aroma of burning credibility.

Through its tangled web of financial relationships with pharmaceutical companies, the medical establishment has generated a crisis of public trust in doctors, still rightly revered as caring healers, but equally scorned for too often having their stethoscopes in the trough.

Yet as the revelations of the lavish wining and dining continue to flow, so too has the soul-searching, and there are now major moves worldwide to try and end the sleazy affair, get doctors out of bed with drug companies, and forge a new independence in the relationship. And that can only be good news for all of us, if the prescriptions of our health care professionals become less based on marketing and more on rigorous independent science.

In the world of sex research, the loose global network known as the New View has been exposing the way the influence of pharmaceutical marketing has reached into the very definition of medical conditions. The New View’s co-founder Dr Leonore Tiefer is now regularly quoted in media, offering the public and the health professionals ready access to an alternative viewpoint – suggesting that the ordinary ups and downs of life are being portrayed as the symptoms of conditions like ‘hypoactive sexual desire disorder’, HSDD – a sub-disorder of FSD – in order to expand markets for pills.

While corporate marketing claims HSDD affects one-in-ten women, New York University’s Tiefer has questioned whether HSDD is real. “Here is the perfect opportunity to create a disease condition where really nothing exists” Tiefer says in Sex, Lies and Pharmaceuticals, arguing drug companies are trying to create new norms of high and constant desire. “Its sinister and its insidious” she says.

The work of Tiefer and other critics over recent years has arguably been very influential, and there are proposals currently being debated to abandon the term ‘HSDD’, and subsume it into a new entity, combining desire and arousal problems, with more focus on relationships than individual sexual dysfunction, and a requirement that symptoms are more severe and long lasting before a woman qualifies for a diagnosis. The new approach will see future estimates of the numbers suffering FSD far lower than the absurd claims of 43 per cent of all women.

But not all areas of medicine, and not all contentious conditions, have benefitted from the scrutiny of a ginger group like the New View. If you start to look closely at the panels of experts who sit down and write the definitions of disease and guidelines for treatment – the people who actually define the boundaries of human illness – you will find an extraordinary degree of entanglement with the drug companies who stand to profit from expanding those boundaries. And expansion is the order of the day.

In recent years we’ve seen the rise of conditions like ‘Adult ADD’ giving fathers access to the same quality amphetamines their kids are taking; we’ve watched the creation of ‘prehypertension’ which labels tens of millions of people with perfectly normal levels of blood pressure; and we’ve witnessed the promotion of ‘pre-osteoporosis’ or osteopenia – a condition where an otherwise healthy woman is deemed to be sick because she is at risk of being at risk of a future fracture, and sometimes even targeted with potentially dangerous long-term medicines.

Infamously, among the panel which radically expanded the numbers of people classified as having ‘high cholesterol’ a few years ago, eight of nine experts had ties to drug companies.

Growing alarm about the closeness between doctors and drug companies has caused many organisations around the world to issue calls for something of a clean-up. The Josiah Macy Foundation released a report in 2008 arguing that pharmaceutical funding of medical education was causing a pro-drug bias in what doctors learned, and it called for a comprehensive ban.

In 2009, the prestigious Institute of Medicine in the United States argued that while collaboration with industry was important for discovery and development, the risk of ‘undue influence’ on doctors’ judgements may well be jeopardising the integrity of scientific investigations, patient care, and public trust.

In 2010, as part of the wider healthcare reform in the United States, new national laws were passed mandating that drug companies disclose every payment to doctors over $10, on a publicly searchable website. It’s only a matter of time before similar levels of transparency are legislated in Australia.

Individual hospitals and universities everywhere, including Harvard in recent months, are introducing new regulations, starting to slowly untangle the science from the marketing. But there’s a lot to untangle. A new report out last month found two-thirds of health consumer organisations working with regulatory authorities in Europe were now taking industry money, while at the same time claiming to represent the patient’s voice.

It’s clear drug companies make many medicines that can save lives and ameliorate suffering, and that many of our doctors are compassionate, caring, hard-working professionals. But it’s also obvious that the amorous relationship between these two sectors is having profoundly unhealthy effects on the way medicine is practised, and the way human experience is being redefined as treatable illness.

The bizarre corporate attempts to fit the square peg that is the complexity of our sexual difficulties into the round hole of a simple drug solution may well prove to be a turning point in medical science, helping to spark a fundamental reassessment of the often unhealthy business of healthcare.

This is the third article in a three-part series. Part 1 and Part 2 were published earlier in the week.